Abstract: A bone plate clamp includes a C-shaped frame with opposing arms spaced apart about a bridge portion. One arm includes a threaded bore into which an adjustable clamping screw having a clamping end is inserted. The clamping screw defines a longitudinal drill guide. The opposite arm has a V-shaped surface oriented to support the bone at two points on the opposite side of the bone from the clamping end of the screw such that the bone clamp securely holds the bone and the bone plate together at three points. The bridge portion is structured to flex when the clamp applies a compressive force between the first and second arms. Flexing of the bridge applies a preload to the clamp which allows the clamp to function as a spring and maintain compression over a range of bone-plate dimensions. The bone plate clamp also includes a removable handle.

Abstract: An apparatus for the transoral invagination and fundoplication of the stomach to the esophagus includes a clip applier having sharp toothed jaws for grasping and damaging the fundus prior to applying the clip. The clip applier has an overall diameter of less than 7 mm. The clip applier jaws are coupled to a pull wire via a linkage which increases the mechanical advantage and thus permits greater grasping force. A plurality of clip designs are also provided.

Abstract: Removable guide tips are pre-assembled into threaded holes of a fracture fixation plate. The guide tips may be used with or without drill guides to guide a drill along the axes of threaded holes defined in the plate. In addition, the tips may be used with bending tools to contour the plate laterally, longitudinally and with twist. More particularly, such plate contouring can be performed while the plate is located on the bone.

Abstract: Removable guide tips are pre-assembled into threaded holes of a fracture fixation plate. The guide tips may be used with or without drill guides to guide a drill along the axes of threaded holes defined in the plate. In addition, the tips may be used with bending tools to contour the plate laterally, longitudinally and with twist. More particularly, such plate contouring can be performed while the plate is located on the bone.

Abstract: A bone plate includes at least one torsional modification feature (TMF). Each TMF is structured to decrease the torsional rigidity of the plate relative to longitudinally opposite portions, but may be modified to increase the torsional rigidity thereat. Each TMF is defined by beams contiguous with the lateral sides of the plate, and an opening extending laterally therebetween. In a preferred embodiment, opposed projections extend into the opening to define threaded discontinuous wall portions for receiving an insert, such as a set screw. In one embodiment, bioabsorbable and/or bioactive inserts may be used to temporarily increase the torsional rigidity of the plate during initial fixation and thereafter have reduced torsional rigidity to mimic normal callus. The plate is preferably used with fixed angle fasteners that may be subject to high torsional loads post-operatively.

Abstract: A medical method includes sliding two substantially straight unconnected arms over a fold of body tissue such that a first arm contacts a first portion of the fold and a second arm contacts a second portion. Then, each arm is bent completely through the fold such that both of the arms compress the portions of the fold into contact with each other. Another method includes releasably coupling first and second substantially linear arms to a bridge, each of the arms having a substantially straight sliding portion and a bendable piercing portion. The arms are slid over opposing sides of two body tissue layers, the first arm sliding over the first layer and the second over the second layer. While the sliding portions of the arms remain substantially straight, each piercing portion is bent completely through the adjacent layer and halfway through the other layer to compress the two layers together.

Abstract: An apparatus for the transoral invagination and fundoplication of the stomach to the esophagus includes a clip applier having sharp toothed jaws for grasping and damaging the fundus prior to applying the clip. The clip applier has an overall diameter of less than 7 mm. The clip applier jaws are coupled to a pull wire via a linkage which increases the mechanical advantage and thus permits greater grasping force. A plurality of clip designs are also provided.

Abstract: A clip applier includes a flexible coil with a manual actuator coupled to one end and a jaw assembly coupled to the other end. A store of clips is adjacent to the jaw assembly and a clip pusher is adjacent to the store of clips. The actuator includes a lever for opening and closing the jaws, a knob for rotating the jaw assembly, and a crank for dispensing clips. The knob and the lever are coupled to a single control member which extends through the coil to a joiner where it is joined to a pair of pull wires coupled to the jaws. The crank is coupled to a second control member which is threaded along a portion. The threaded portion engages a threaded member coupled to the pusher such that rotation of the threaded control member by the crank causes the pusher to be moved distally.

Abstract: A bone fixation system includes a plate and a set of fixation locking screws. The plate defines a set of locking screw holes each having an internal thread. Each respective locking screw has a head with an external structure that is adapted to self-tap into the internal thread of a given locking screw hole to secure the respective first-type fixation locking screw at an surgeon-directed angle relative to the plate. This angle is defined during forcible insertion and rotation of the respective locking screw into the given screw hole. The system may also include unidirectional locking screws. In a preferred embodiment the plate and first-type of screw are made of different metals, with the plate made of titanium alloy and the screw made of cobalt chrome alloy.

Abstract: A fracture fixation plate system for use on a long bone having a metaphysis and a diaphysis, includes at least one end plate having a head portion for the metaphysis, and at least one diaphyseal plate having a first end and a second end with a plurality of screw holes therebetween. The end plate includes mating structure adapted to mate with and securely couple to at least one end of the at least one diaphyseal plate. The system preferably includes several end plates and diaphyseal plates to accommodate anatomy of various sizes.

Abstract: A surgical clip applier includes a clip chamber defined at the distal end of the instrument. A clip chain of at least two clips is provided in the clip chamber. The clip chain is coupled such that both relatively distal and proximal movement of the proximalmost clip of the clip chain within the chamber results in longitudinal translation of clips within the chamber.

Abstract: A retractor for manipulating an object includes a body having proximal and distal ends, a retraction device, and an actuation device. The retraction device has a head connected to the distal end of the body, substantially rigid needles, and an actuator. The head has a pivot. The needles are pivotally connected to the head about the pivot. The actuator is operatively connected to the needles and is movably disposed within the head and/or the body. The actuation device is connected to the proximal end of the body. The actuation device is operatively connected to the actuator through the body and, upon actuation thereof, moves the actuator to selectively rotate the needles between a stowed position where the needles are stowed within the head and a fully extended position where the needles are extended out of the head.

Abstract: A fracture fixation plate system for use on a long bone having a metaphysis and a diaphysis, includes at least one end plate having a head portion for the metaphysis, and at least one fragment plate having a first end and a second end with a plurality of screw holes therebetween. The end plate includes mating structure adapted to mate with and securely couple to at least one end of the at least one fragment plate. The system preferably includes several end plates and fragment plates to accommodate anatomy of various sizes.

Abstract: A flexible clip applier includes a flat wire wound outer tubular coil, a pair of jaws at the end of the coil, end effector wires extending through the coil and coupled to the jaws, and a clip-advancing wire extending through the coil. A large pushing force to advance a clip is created by providing a compressive force to the outer tubular coil to increase its tensile limitation, and providing a force which is compressive to the clip-advancing wire and tensile to the tubular coil while maintaining the compressive force on the tubular coil.

Abstract: A surgical instrument includes an end effector having a clevis and first and second jaws mutually rotatable between open and closed positions. The jaws are proximally directed and laterally displaced relative to a longitudinal axis of a control shaft of the instrument. The jaws hold first and second parts of a fastener, respectively. The first part includes a base having upstanding tissue piercing posts, and the second part includes another base defining apertures for receiving the posts, as well as a portion movable relative to the second base. When the upstanding posts are inserted into the apertures, the movable portion can be moved into a second configuration to lock the parts of the fastener together. The instrument is adapted to move the second part into the second configuration. A method for using the apparatus and fastener are also provided.

Abstract: A flexible endoscopic dip applier includes a flexible coil with a manual actuator coupled to one end and a jaw assembly coupled to the other end. A store of clips is arranged adjacent to the jaw assembly and a clip pusher is arranged adjacent to the store of clips. The actuator includes a lever for opening and closing the jaws, a knob for rotating the jaw assembly, and a crank for dispensing clips. The knob and the lever are coupled to a single control member which extends through the coil to a joiner where it is joined to a pair of pull wires coupled to the jaws. The crank is coupled to a second control member which is threaded along a distal portion. The threaded portion engages a threaded member near the pusher and is coupled to the pusher such that rotation of the threaded control member by the crank causes the pusher to be moved distally.

Abstract: A flexible endoscopic clip applier includes a flexible coil with a manual actuator coupled to one end and a jaw assembly coupled to the other end. A store of clips is arranged adjacent to the jaw assembly and a clip pusher is arranged adjacent to the store of clips. The actuator includes a lever for opening and closing the jaws, a knob for rotating the jaw assembly, and a crank for dispensing clips. The knob and the lever are coupled to a single control member which extends through the coil to a joiner where it is joined to a pair of pull wires coupled to the jaws. The crank is coupled to a second control member which is threaded along a distal portion. The threaded portion engages a threaded member near the pusher and is coupled to the pusher such that rotation of the threaded control member by the crank causes the pusher to be moved distally.

Abstract: A surgical instrument includes an end effector having a clevis and first and second jaws mutually rotatable between open and closed positions. The jaws are proximally directed and laterally displaced relative to a longitudinal axis of a control shaft of the instrument. The jaws hold first and second parts of a fastener, respectively. The first part includes a base having upstanding tissue piercing posts, and the second part includes another base defining apertures for receiving the posts, as well as a portion movable relative to the second base. When the upstanding posts are inserted into the apertures, the movable portion can be moved into a second configuration to lock the parts of the fastener together. The instrument is adapted to move the second part into the second configuration. A method for using the apparatus and fastener are also provided.

Abstract: A flexible clip applier includes a flat wire wound tubular coil, a pair of jaws at the end of the coil, end effector wires extending through the coil and coupled to the jaws, and a clip-advancing wire extending through the coil. A proximal handle is adapted to impart tensile force the end effector wires and the tubular coil, and compressive force to the clip-advancing wire and tubular coil to thereby effect advancement of a clip into the jaws and over tissue compressed between the jaws, and deformation of the clip over the tissue.

Abstract: A flexible clip applier includes a flat wire wound tubular coil, a pair of jaws at the end of the coil, end effector wires extending through the coil and coupled to the jaws, and a clip-advancing wire extending through the coil. A clip chamber is defined in the distal end of the coil. A clip pusher is provided at a distal end of the clip-advancing wire, and advances a clip into the jaws when the clip-advancing wire is moved distally. The jaws include channels in which a distalmost clip rides when the jaws are closed and the pusher is advanced, thereby causing the distalmost clip to be pushed over the tissue, and a distal anvil which operate to bend a portion of the clip to facilitate its retention on the clamped tissue. The device can push a clip with a force in excess of 1500 grams.